Syncope resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2]
Definition
Syncope is defined as a transient LOC, characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Management
Syncope in the Context of Transient LOC
| Determine if there was LOC | |||||||||||||||||||||||||||||||||
| If yes: ❑ Rapid onset? ❑ Short duration? ❑ Spontaneous complete recovery? | If no: | ||||||||||||||||||||||||||||||||
| If no to ≥1; exclude the following before proceeding with syncope evaluation: ❑ Coma ❑ Aborted SCD ❑ Epilepsy ❑ Metabolic disorders: ♦ Hypoglycemia ♦ Hypoxia ♦ Hyperventilation with hypocapnia ❑ Intoxication ❑ Vertebrobasilar TIA | If yes: ❑ Transient LOC | ||||||||||||||||||||||||||||||||
| Non traumatic | Traumatic | ||||||||||||||||||||||||||||||||
| Suspect: | |||||||||||||||||||||||||||||||||
Diagnostic Flowchart in Patients with Suspected Syncope
Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. [3]
Do's
Don'ts
CSM should be avoided in patients with previous TIA or stroke within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.
References
- ↑ Khoo, C.; Chakrabarti, S.; Arbour, L.; Krahn, AD. (2013). "Recognizing life-threatening causes of syncope". Cardiol Clin. 31 (1): 51–66. doi:10.1016/j.ccl.2012.10.005. PMID 23217687. Unknown parameter
|month=ignored (help) - ↑ Kapoor, WN. (2000). "Syncope". N Engl J Med. 343 (25): 1856–62. doi:10.1056/NEJM200012213432507. PMID 11117979. Unknown parameter
|month=ignored (help) - ↑ Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A; et al. (2009). "Guidelines for the diagnosis and management of syncope (version 2009)". Eur Heart J. 30 (21): 2631–71. doi:10.1093/eurheartj/ehp298. PMC 3295536. PMID 19713422 Check
|pmid=value (help).
| Suspected syncope: ❑ Initial Assessment] | |||||||||||||||||||||||||||||||||
| {{{ B01 }}} | |||||||||||||||||||||||||||||||||
| Syncope | T-LOC non syncopal | ||||||||||||||||||||||||||||||||
| Certain diagnosis of syncope: ❑ Go to Diagnostic Evaluation algorithm for management of specific type of syncope | Uncertain etiology | Confirm with specific test OR specialist | |||||||||||||||||||||||||||||||
| High risk: ❑ Early Evaluation and treatment | Low risk, recurrent syncopes: ❑ Cardiac or neurally mediated tests as appropriate OR Delayed treatment guided by EKG documentation | Low risk, single or rare syncope: ❑ No further evaluation | |||||||||||||||||||||||||||||||